Panel discusses Medicaid, but few show up to speak

How does Missouri’s Medicaid program work now? How might it work if changed and expanded with federal incentives under Obamacare?

Those were among the broad questions that a 50-member group – the Citizens and Legislators Working Group on Medicaid Eligibility and Reform – took up Wednesday at its first meeting, held in Independence.

How does Missouri’s Medicaid program work now? How might it work if changed and expanded with federal incentives under Obamacare?

Those were among the broad questions that a 50-member group – the Citizens and Legislators Working Group on Medicaid Eligibility and Reform – took up Wednesday at its first meeting, held in Independence.

The group was scheduled to go all day, but only three people testified, which disappointed the group’s chairman, state Rep. Noel Torpey, R-Independence. More meetings around state are in the coming weeks.

“It’s very important to hear from the citizens of Missouri,” Torpey said.

The group is one of three appointed by leaders of the Missouri General Assembly to study the issue. Gov. Jay Nixon had pushed the legislature to take the federal government’s offer under the Affordable Care Act to expand the program, giving health insurance to about 300,000 more Missourians. About 875,000 people are on Medicaid – called MO Healthnet – currently. The legislature took no action on Nixon’s plan, but leaders have said they’ll address it in 2014. The committees are assigned to study the issue and make recommendations.

John W. Bluford, president and CEO of Truman Medical Centers, said Missouri hospitals are caught in a squeeze as federal payments to offset the costs of uncompensated care are being cut but the added revenues from Medicaid aren’t materializing if the state doesn’t expand the program.

“They are very skittish about their long-term survival,” he said.

He used TMC – both at Hospital Hill and at Lakewood, a hospital that serves much of Eastern Jackson County – as an example. Hospitals by law have to treat people in emergencies, whether or not the person can pay. Across the state, hospitals provide about $1 billion in uncompensated care annually, and 11 percent of that is at just TMC’s two facilities.

TMC serves about 100,000 patients a year, 30,000 of whom don’t have the means to pay. Expanding Medicaid as Washington envisions and as Nixon proposed would cut that 30,000 by half. For now, those 30,000 are costing TMC $130 million a year, and Bluford said the cuts to federal funds to help make up for that hurt.

“If there’s anything that’s real or true about the Affordable Care Act, it’s that these cuts are happening,” he said.

Many patients, he said, are dealing with an entire web of health risks and related issues, and tackling those comprehensively helps patients and saves money – but Medicaid doesn’t pay for that. TMC has a three-year federal grant to address those issues for about 3,000 people.

“We really need insurance reform, for Medicaid and Medicare, to pay us to keep people healthy rather than paying for sickness,” Bluford said.

Brian Kinkade, acting director of the Missouri Department of Social Services, walked through some of the basic math of Medicaid.

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As of March, 873,466 people were enrolled in the program. Its use is highest in southeast and south-central Missouri and in urban areas. Of those 873,466, 60.9 percent were children, and another 11.9 percent are pregnant women or the custodial parents of children on Medicaid. Also, 18.4 percent are people with disabilities – many with mental health issues that keep them from working – and 8.6 percent are elderly people with low incomes.

“Medicaid participation primarily ... is a function of income,” he said.

One main idea is to make sure children get good screening and preventive care – that’s inexpensive compared with other medical expenses and it saves money later – so they can do well in school and grow up healthy. One example: Medicaid generally doesn’t pay for braces, but it will if those are used to address an underlying medical issue.

“Children tend to be less costly,” Kincade said.

The Medicaid population is sharply lower than it was a few years ago. It briefly reached just more than 1 million, but in 2005 and 2006 the General Assembly cut the program, taking about 200,000 people off the rolls. Enrollment rose some during the Great Recession but has been “remarkably stable” since 2010, Kinkade said.

Expanding the program as Nixon proposes would mean health coverage for adults without disabilities and adults without children.

“That’s a watershed change for the Medicaid program,” he said.

Legislative leaders have said any expansion of Medicaid will have to be accompanied by significant reforms as well.

State Sen. Paul LeVota, D-Independence, is on a similar committee of senators. That group met Tuesday in Jefferson City.

“A lot of people think we need to reform Medicaid, and that includes expansion. And I think the committee heard that loud and clear today,” he said Tuesday.

The committee is looking at access, affordability and quality of care, he said.

“The goal for the Senate committee is to have legislation pre-filed by Dec. 15,” he said.